Retrospective study of glaucoma and closed-eyelid test: long-term outcomes in an Italian native population

AIM: To establish a threshold value of intraocular pressure (IOP) increase after the closed-eyelid test (CET) that correlates with the highest probability of developing overt primary open-angle glaucoma (OAG) in an Italian native population from 1980 to 2010. METHODS: Retrospective analysis of data obtained from 161 patients with ocular hypertension who performed the CET in 1980, and were subsequently followed to see whether they developed OAG. CET was performed always in the morning Eyelids were closed by bandaging for 1 h in a quiet environment, with the patient seated and not sleeping. IOP was measured again 8 to 10s after opening the eyelids. RESULTS: Accurate statistical analysis of the obtained values indicated that 77% of the subjects showing an IOP increase after 1 hour of eyelid closure in a sitting position developed OAG in the following 30 years and that IOP increase values above 4 mmHg led to a subsequent diagnosis of glaucoma in more than 80% of the patients. CONCLUSION: Eyelid closure for 60 minutes results in a net elevation of IOP the extent of which depends on the balance between the increase of aqueous humour secretion and its outflow. Therefore, the CET may discriminate individuals with a normal outflow from individuals with a less functional outflow, which are evidently those at a higher risk of developing glaucoma.